Predicting and grading the degree of difficulty of cochlear implant surgery by evaluating temporal bone using high resolution computed tomography and magnetic resonance imaging

Background: The current study was designed to assess the challenges that arise during cochlear implantation. Hence imaging based grading system, using a structured, 12-point scoring chart was developed with an aim to assess various anatomical factors of temporal bone helpful in contemplating complications involved in surgery and to assess various congenital and acquired abnormalities if detected during scan which can affect cochlear implant surgery.Methods: This was a descriptive study done on 60 patients with sensorineural hearing loss. They were evaluated preoperatively by using HRCT and MRI findings and subsequently underwent cochlear implantation. A 12-point scoring chart was developed based on imaging findings. Surgical times were noted in each case and each imaging point on the scoring chart was correlated with the surgical times.Results: Eleven out of 12 points in the scoring chart proved to be statistically significant in predicting the degree of difficulty of the surgical procedure. One point was not correlating with the surgical timings. Based on the grading system, in the present study, there were 37 patients (61.66%) classified as Grade 1, 16 patients (26.67%) classified as Grade 2 and 7 patients (11.67%) classified as Grade 3.Conclusions: These radiological image findings and its related grading system are relatively easy and quick to assess on readily available pre-operative temporal bone CT scan and MRI. They can form a pre-operative checklist that provides a formalized approach for the surgeons and, in particular surgical trainees, predict and, thus prepare for, potentially challenging cochlear implant cases

The Effect of Pain and Swelling Related to Third Molars on Oral Health-Related Quality of Life

Objective: To evaluate the effect of pain and swelling related to third molars on patients' quality of life prior to third molar surgery. Material and Methods: The effects on quality of life with reference to oral health of 246 healthy patients seeking treatment of third molars were analyzed using the 14-item Oral Health Impact Profile (OHIP) questionnaire before surgery. The patients' sociodemographic characteristics, medical and dental history, reasons for third molar removal were recorded. Adverse effects of pain and swelling on oral health-related quality of life were recorded. Results: The mean age of the patients included in the study was 23.15 years, with maximum male patients and the mean OHIP-14 score of 8.01 ± 7.51. About 36.97% of patients reported that their chief complaint was pain/swelling due to third molar infection, and 27.9% of subjects reported one or more of the 14 OHIP items. The odds of reporting for age with ≥25 years was approximately 2 times greater than age with ≤25 years (OR=1.56, 95% CI: 1.01-2.57) and tooth loss due to traumatic history (OR=3.14, 95% CI: 2.12-6.54). Conclusion: Adverse influences on quality of life were seen in a significant number of patients seeking third molar removal. The probabilities increased by 3-fold for patients who had experienced pain or swelling than asymptomatic individuals

The Effect of Pain and Swelling Related to Third Molars on Oral Health-Related Quality of Life

Objective: To evaluate the effect of pain and swelling related to third molars on patients' quality of life prior to third molar surgery. Material and Methods: The effects on quality of life with reference to oral health of 246 healthy patients seeking treatment of third molars were analyzed using the 14-item Oral Health Impact Profile (OHIP) questionnaire before surgery. The patients' sociodemographic characteristics, medical and dental history, reasons for third molar removal were recorded. Adverse effects of pain and swelling on oral health-related quality of life were recorded. Results: The mean age of the patients included in the study was 23.15 years, with maximum male patients and the mean OHIP-14 score of 8.01 ± 7.51. About 36.97% of patients reported that their chief complaint was pain/swelling due to third molar infection, and 27.9% of subjects reported one or more of the 14 OHIP items. The odds of reporting for age with ≥25 years was approximately 2 times greater than age with ≤25 years (OR=1.56, 95% CI: 1.01-2.57) and tooth loss due to traumatic history (OR=3.14, 95% CI: 2.12-6.54). Conclusion: Adverse influences on quality of life were seen in a significant number of patients seeking third molar removal. The probabilities increased by 3-fold for patients who had experienced pain or swelling than asymptomatic individuals

Tooth Coronal Index: A Novel Tool For Age Estimation on Cone-Beam Computed Tomography

Objective: To evaluate dental age assessment reliability through Tooth Coronal Index (TCI) method. Material and Methods: The cone-beam computed tomography (CBCT) scans of 160 individuals aged between 20-70 years were analyzed in the present study. The height of the crown, i.e., coronal height, and the height of the coronal pulp cavity, i.e., coronal pulp cavity height, of mandibular second premolars and first molars were calculated and then TCI was measured. The actual age of a subject was compared with TCI of tooth and the acquired data were subjected to Pearson’s correlation and unpaired t-tests. Results: Negative correlation was observed between the real age and TCI of mandibular first molar (r = -0.094, p=0.382) and second premolar (r = -0.176, p=0.0961. Statistically significant difference was observed between actual age and TCI for mandibular second premolar and first molar (p<0.001). Conclusion: Tooth coronal index has the potential to estimate age of an individual on CBCT scans. It is simple, cost-effective than histological methods and can be applied to both living and unknown dead

Mycobacterium tuberculosis Response Regulators, DevR and NarL, Interact in Vivo and Co-regulate Gene Expression during Aerobic Nitrate Metabolism

Mycobacterium tuberculosis genes Rv0844c/Rv0845 encoding the NarL response regulator and NarS histidine kinase are hypothesized to constitute a two-component system involved in the regulation of nitrate metabolism. However, there is no experimental evidence to support this. In this study, we established M. tuberculosis NarL/NarS as a functional two-component system and identified His(241) and Asp(61) as conserved phosphorylation sites in NarS and NarL, respectively. Transcriptional profiling between M. tuberculosis H37Rv and Delta narL mutant strain during exponential growth in broth cultures with or without nitrate defined an similar to 30-gene NarL regulon that exhibited significant overlap with DevR-regulated genes, thereby implicating a role for the DevR response regulator in the regulation of nitrate metabolism. Notably, expression analysis of a subset of genes common to NarL and DevR regulons in M. tuberculosis Delta devR, Delta devS Delta dosT, and Delta narL mutant strains revealed that in response to nitrite produced during aerobic nitrate metabolism, the DevRS/DosT regulatory system plays a primary role that is augmented by NarL. Specifically, NarL itself was unable to bind to the narK2, acg, and Rv3130c promoters in phosphorylated or unphosphorylated form; however, its interaction with DevR similar to P resulted in cooperative binding, thereby enabling co-regulation of these genes. These findings support the role of physiologically derived nitrite as a metabolic signal in mycobacteria. We propose NarL-DevR binding, possibly as a heterodimer, as a novel mechanism for co-regulation of gene expression by the DevRS/DosT and NarL/NarS regulatory systems